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Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. _ �' DESIGNATED FACILITY TO GENERATOR UNIFORM HAZARDOUS General r ID um er b S 2 2. Pae 1 of nse Phone 4. Manifest Track' Number 9 60144 JJ K WASTE MANIFEST 5. GUPfq yailingAddress GWgs d ft (if different than mailing address) Attn: Pat Guigermety, 52W Sheila Street 1990 PIccod Rd. Commerce CA 90CAO Stooldon CA 95215 323 284 5200 Generators tQPhone: 6. Trans i41rIt Ticar5 a! IIC. t. XI i NU h C 0 0 1 2 $ Q 7. Transporter 2 Company Name U.S. EPA ID Number 8. waked kciNfimd Site Address U.S. EPA ID Number 1630 W. 171h Street Lang Beach CA 90813 562 432-5445 C A 0 0 2 8 4 0 9 0 1 9 Facility's Phone: 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group if an 9 P C Y)) Ouan6 ty WLNol. X t 2.1 aerascla) h 1 1331 3 i 0 DM -5 P Z WRECrV 2. TF t 7 3. JUL 2 8 2014 4. EP T I IVI L- 14. Special Handling Instructions and Additional Information 9b.1) Aerosols Profile#51192 ERG:126 t �� Gloves 6 Goggles 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. /�//`rontedd(fyped Nja/y_Ie /J Signatur Month D+ayy Year Gene 27�esRn110 .i 16. Intemational Shipments 1:1Import to U.S. ElExport from U.S. Port of entryit: Transporter signature (for exports only): Date leaving U.S.: w 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedliy d Name Signatur Month Day Year a ./ 71A QT nsporter 2 Printed/Typed Name 51gnatur Month Day Year t- 18. Discrepancy 18a. Discrepancy Indication Space ❑ O.antity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Allemate Facility (or Generator) . HANDLED AND STORED FOR SUBYE�MWOOW'ft WANE WAS RECENID :3 Ti(E Rff.EP,C7•rCFD TREATNIE:Yr OR REUSE CROSBY & OV=RTON. INC OPERATES THE FACILM UNDEIt V Q t1 )!,P -'SAL. > ri,irl'c GRAr TL'D TO TF ENi• ilX 1,JTL DE.t'.v..RT1IFN`1' OF TOXIC SUBS'TANC� C N -,R04 TOGMEA Facility's Phone: e Y2t!?TC i lON ACE. N':X IN ACCORDANCE WriN ' T PROVISIONS Or W 18c. Signature of Alternate Facility (or Generator) lc R73OL'RC3 CONSERVATION AND RECOVERY AC -1. OE 15 Month Day Year QTr%R.I. AND STATE RECULATIONS. C'KOSB1' a OVCRTON HAS ALL Of 110? NEWSnR'r WASTE AND ALL THE WASTE HAS BEEN HANDLEP1 Z ACCEPT TILE REiT3tENC:1) as19. Hazardous Waste Report Management Method Codes (i.e., coclbV&'Nizh dous waste treatment, disposal, and recycling systems) LLJ 1 12. } 3. 4. 20. Designated Facility Owner or Operator. Ceftificatiorkof receipt of hazardous materials covered by the manifest except as note in.0 18a Printed/Typed Name SignatureMon �a Yea 7� :�t W1 m I I- /-ull l tf � EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. _ �' DESIGNATED FACILITY TO GENERATOR